Sir, recent correspondence in the BDJ wrongly equates oral surgery with being only dentoalveolar surgery. What oral surgery consists of should be clarified, and thus a clear view of its future role in the NHS can be developed.

Oral surgery falls under the EU dental directives and allows oral surgeons to carry out procedures similar to OMFS apart from oral cancer, and facial deformity. With appropriate training, competencies include fractures of the facial skeleton, treatment of the TMJ and other jaw anomalies, and salivary gland disease. Your previous correspondents may be interested to know that no matter how high GDS tariffs go, these oral surgery procedures are unsuitable for the primary care sector. With current shortfalls in service provision, there is a strong argument that dentally qualified oral surgeons can provide a valuable consultant led service for the population. With cancer, and cleft lip/palate services being centralised, the extra training that maxillofacial surgeons have undergone can be effectively used in tertiary referral centres. Oral surgeons can thus provide the full range of oral surgery in a consultant led service.

Is there an argument then for a 'divorce' between oral and maxillofacial surgery? Under modernising medical careers, the length of SPr training will be reduced, and I suspect that a four-year programme is insufficient to encompass the whole of oral and maxillofacial surgery. By separating the two specialities, dental graduates can be trained in the complete remit of oral surgery, and medical graduates in maxillofacial surgery, giving both specialities the important training and experience they deserve. The argument that leaving out one undergraduate degree may miss conditions is invalid in the current age of multi-disciplinary team working as well as working within one's own area of competence. Apart from occlusion, and diagnosis of dental pain, it is hard to see why a medical graduate wishing to pursue maxillofacial surgery requires a dental degree.

Hopefully, the re-organised SAC in Oral Surgery will investigate these matters in a positive and constructive manner. The RCS England's current report Developing a modern surgical workforce Jan 2005, (Table p.13) indicates consultant shortfalls in OMFS currently (103) and the predicted shortfall in 2009 (212). This significant shortfall is not due to any dramatic increase in demand for oral cancer or facial deformity.

An attractive training pathway can thus ensure that the demand for a consultant led service in oral surgery can be met, and would no doubt be popular with dental graduates and oral surgery departments.